The economic evaluation of a Participatory Ergonomics programme to prevent low back and neck pain

This study was an economic evaluation conducted alongside a cluster randomised controlled trial with a follow-up of 12 months. The aim was to evaluate the cost-effectiveness and cost-benefit of the Stay@Work Participatory Ergonomics programme (PE) compared to a control group (no PE). In total, 37 departments (n=3047 workers) were randomised into either the intervention (PE) or control group (no PE). During a meeting, working groups followed the steps of PE, and composed and prioritized ergonomic measures aimed to prevent low back pain (LBP) and neck pain (NP). Working groups had to implement the ergonomic measures within three months in their department. Cost data included those directly related to LBP and NP. Cost-effectiveness analyses (CEA) and cost-benefit analyses (CBA) were performed. After 12 months, health care costs and costs of productivity losses were higher in the intervention group than in the control group (the mean total cost difference was $/euro$127; 95% CI $/euro$-164 - $/euro$418). From a societal perspective, the CEA showed that PE was not cost-effective compared to control for LBP and NP prevalence, work performance, and sick leave. The CBA from a company perspective showed a monetary loss of $/euro$78 per worker. The PE programme was neither cost-effective nor cost-beneficial on any of the effect measures.     

A new model for vocational rehabilitation at an organizational level -- a pilot study with promising results

Sick leave has negative economic consequences for companies. The aim of this study was to implement the model Organizational Rehabilitation in two departments at an industrial company in the county of J?mtland, Sweden, to see if it was possible to reduce the costs due to sick leave. The rehabilitation model consisted of three steps and combined economy and productivity with a good psychosocial work environment, measuring the result in costs. Step 1 consisted of a problem inventory among all co-workers, step 2 semi structured interviews with all co-workers regarding how they experience their work environment and step 3 individual agreements regarding rehabilitation interventions, i.e. interventions where the individual's specific needs and wishes outlined the foundation for rehabilitation measures with the objective of increasing work capacity. The costs were measured at the start and end of the project. The study showed that it is indeed possible to reduce both sick leave and costs. During the study, the organization reduced current sick leave from 12% (2003) to 3% (Nov. 2004) and the costs per employee from euro1 860 per month (2003) to euro440 per month (Nov. 2004). This will make an estimated saving for 2005 of euro470 000. It should be noted that the study is small and should not be generalized, but may be seen as a positive indication regarding the model organizational rehabilitation. Further research is needed.     

Significant resources needed for return to work after sick leave

There are increasing numbers of people on long-term sick leave, especially with stress-related ill health and musculoskeletal disorders. The main purpose of this study is to, early on in the sick leave, find predictors of individual resources for a return to work. The study group consists of women and men on sick leave compared with reference groups of healthy persons. A questionnaire was used regarding diagnosis given on the doctor's certificate, self-reported symptoms, residential area, education, and kind of work. It also contained open questions about consequences in daily life and beliefs about future. Checklists concerning life satisfaction, sense of coherence, locus of control, coping resources and sick leave information over a four-year period have been used. Significant differences between the study group and the reference groups were found, relating to sense of coherence, locus of control, life satisfaction and coping resources. More than half of the study group were still on sick leave at a two-year follow-up. Important predictive factors turned out to be: previous sick leave, own belief about future and self-reported symptoms.     

Individual status at the start of rehabilitation: Implications for vocational rehabilitation programs

This research investigated the situation of 143 unemployed sick leavers at the start of vocational rehabilitation in Sweden. It is argued in this paper that in order to gain a meaningful picture of the vocational rehabilitation process it is necessary to know and understand something of individual differences and status at the onset. In doing so, assessment was carried out of the possible influence of one contextual factor and five individual factors on health, duration of sick leave and unemployment. Findings suggest that individual differences exist in health status, length of sick leave and unemployment, at the upstart of vocational rehabilitating. Locus of control was found to exert important influence on the differences between the individuals in the study sample, with persons of external locus of control having a less favourable point of departure at the start of vocational rehabilitation compared to other groups. It is therefore assumed that these persons will be in greater need of support during the vocational rehabilitation process. The level of unemployment within a geographical area was also found to influence the length of sick leave. CONCLUSIONS: Our suggestion is for rehabilitation programs to be developed and selected to match the special needs and differences whether they are of individual or of social nature.     

Assessment of long-term work attendance within human service organisations

Terms and theories of work attendance vary according to their use and focus. This paper analyzes long-term work attendance in relation to social, psychosocial, and health-related factors. Register-based and questionnaire-based data covering 3,804 human service organisation workers over a three-year period were analyzed at individual and work-unit level. The results showed positive relationships between work attendance and male gender, high income, work commitment, job satisfaction, and having positive feelings towards work. High work attendance combined with work commitment, stress, or pain did not show any negative long-term effects upon short-term or long-term sick leave. Instead, work attendance seemed to be more associated with stable patterns of behaviour. Register-based measures of work attendance (at most 4-7 days of sick leave per worker per year) may be a useful tool in managing psychosocial work environment and related behaviour, but their inability to encompass information regarding individual health and disease must be borne in mind.     

Self-reported musculoskeletal pain and working conditions among employees in the Swedish public sector

Musculoskeletal disorders constitute a considerable public health problem, often resulting in sickness absence, particularly in public sector employees. Increased knowledge on how this is related to individual and work-related factors is required. The objective of this study was to investigate the associations between self-reported musculoskeletal pain and the following factors: physical and psychosocial work conditions, lifestyle, psychosomatic symptoms and sick leave. A comprehensive questionnaire was completed by a total of 2523 people, of which 87% were women and 13% men. The participants were employed in public hospitals, educational institutions, home care services for the elderly and domestic/catering services in a Swedish county. The response rate was 92%. Multiple logistic regression analyses showed that the high level of self-reported musculoskeletal pain was highly associated with strenuous physical and psychosocial work conditions. The physical factor with the highest odds ratio (OR) was working in a forward-bent position. High work demands was the most prominent psychosocial factor and distinctly associated with musculoskeletal pain among men. Physical work strain and other demanding working conditions, which were associated with musculoskeletal pain, were frequent among employees in home care services for the elderly and domestic/catering services. There was a strong association between long-term sick leave and high musculoskeletal pain. Furthermore, there was a strong association between a high level of musculoskeletal pain and the exhibition of psychosomatic symptoms in both women and men; this is an interaction that may intensify the total experience of illness and thus needs to be further investigated.     

How can occupational health services in Sweden contribute to work ability?

Occupational health service in Sweden is often described as an important and strategic resource to reduce work-related diseases, improve work ability and successfully assess improvement of the workplace. However, not much research has been done on how OHS contribute to reduced absence due to work-related illness or improvement of the work ability of employees. In our study, the ambition has been to describe how OHS can contribute and give effects in client companies. Fifteen companies considered to be good examples were selected in cooperation with the social partners. Semi-structured interviews were carried out with representatives of the company and OHS. The results show that efficient collaboration depend strongly on the relationship between the OHS and the company, and were highly correlated with a continuously dialogue and contact. Good occupational safety and health management at company level was a key factor for effective use of OHS. The strategic collaborations also often led to that OHSs contribution was gradually shifted from a reactive or medical focus to a more proactive approach. Several of the interviewed OHSs also held this strategy to work more with prevention, and focusing on "treating the organization", not the individual, leaving the executive measures to the company.     

Factors relevant to a return to work: a multivariate approach

This paper contributes to the understanding of the factors that are significant for returning to work, and identifies factors that might be used early on in a period of sick leave to discern whether people are likely to work again. In the design, the multivariate Partial Least Squares (PLS) of Latent Structures method was used to analyse information from a questionnaire containing socio-demographic items, and information on symptoms, consequences on daily life, expectations and psychosocial factors. Data about the incidence of sickness over a four-year period was included. 121 adults aged 18-64 years on sick leave participated, irrespective of their diagnoses. A reliable prediction of a return to work required the combination of many factors: individual psychosocial instruments are not useful when considered in isolation. The strongest predictive factors for a return to work concern the individuals' expectations, the number of days of sick leave taken in the past, somatic disorders, and a high level of life satisfaction and sense of coherence. Many factors influence the outcome for people on sick leave: PLS analysis demonstrated that a multivariate approach using this method could predict the long-term outcome early on in a period of sick leave.     

Sick leave -- Cushion or entitlement? A study of age cohorts' attitudes and practices in two Australian workplaces

Stereotypes of older people suggest that they may experience more sickness and injury therefore may not be as productive as younger employees. The present paper attempts to test these stereotypes and reports research into patterns of sick leave in different age cohorts and attitudes towards the use of sick leave. The research was carried out at two case study sites. Managers were interviewed and focus groups were held with workers. A complex pattern was found, suggesting structural issues such as sick leave entitlements, workplace organisation, and flexible work patterns interacted with managers' and workers' attitudes, age, gender and family responsibilities. Flexible workplace hours, and part payment for unused sick leave and insecurity of employment appeared as important factors in reducing absenteeism. The most striking finding was that older workers past pensionable age took the least sick leave. Older workers were careful to conserve sick leave as a 'cushion' for serious illness. Workplace pressures especially those resulting from the failure of management to replace absent workers resulted in work pressure on peers and thus reluctance of workers to take leave.     

Maternal Work Absence: A Longitudinal Study of Language Impairment and Behavior Problems in Preschool Children

Combining work and family responsibilities is challenging when children have special needs, and mothers commonly make employment‐related adjustments. In this study, the authors examined associations between maternal work absence and child language impairment and behavior problems in preschool children. Questionnaire data at child age 3 years from 33,778 mothers participating in the prospective population‐based Norwegian Mother and Child Cohort Study were linked to national register data on employment and long‐term physician‐certified sick leave at child age 3–5 years. Mothers who reported having a child with language impairment had a consistently higher risk of not being employed and were at increased risk of taking long‐term sick leave at child age 5 years. Co‐occurring problems were associated with excess risk. Language impairments in preschool children, in particular when they are co‐occurring with behavior problems, are likely to have a range of negative short‐ and long‐term consequences for the financial and overall health and well‐being of mothers and their families.     

Effects of exercise on health-related quality of life and fear of falling in home-dwelling older women

This randomized, controlled trial evaluated the effects of exercise on health-related quality of life (HRQoL) and fear of falling (FoF) among 149 home-dwelling older women. The 12-mo exercise program was intended to reduce the risk of falls and fractures. HRQoL was assessed by the RAND-36 Survey, and FoF, with a visual analog scale, at baseline, 12 mo, and 24 mo. On all RAND-36 scales, the scores indicated better health and well-being. The exercise had hardly any effect on HRQoL; only the general health score improved slightly compared with controls at 12 mo (p = .019), but this gain was lost at 24 mo. FoF decreased in both groups during the intervention with no between-groups difference at 12 or 24 mo. In conclusion, despite beneficial physiological changes, the exercise intervention showed rather limited effects on HRQoL and FoF among relatively high-functioning older women. This modest result may be partly because of insufficient responsiveness of the assessment instruments used.     

Characteristics of optimum falls prevention exercise programmes for community-dwelling older adults using the FITT principle

This review aims to identify the optimal exercise intervention characteristics for falls prevention among community-dwelling adults aged 60 years and over. Articles for inclusion were sourced by searching the Academic Search Premier, AMED, Biomedical Reference Collection: Expanded, CINAHL Plus, MEDLINE and SPORTDiscus databases with the key words ‘falls’, ‘prevention’, ‘exercise’ and ‘community’ and via reference lists of relevant articles. Only articles of level 1 or level 2 evidence (Howick et al. 2011) were included. Other inclusion criteria included recording falls incidence as an outcome measure, examining a community-dwelling population aged 60 years or over and implementing exercise as a single intervention in at least one group. Exercise programme characteristics from 31 articles were examined according to their frequency, intensity, time and type and their effects on falls incidence were reviewed. Exercising for a minimum of 1 h/week for at least 40 h over the course of an intervention is required to successfully reduce falls incidence. The optimal exercise frequency is three times per week, but the optimal duration per bout remains unclear. Specific balance training of sufficiently challenging intensity is a vital programme component, and strength training is most effective when combined with balance training. Flexibility and endurance training may also be included as part of a comprehensive programme. A combination of group and individual home exercise may be most effective for preventing falls and promoting exercise adherence.     

Report on the implementation and evaluation of an interprofessional learning programme for inter‐agency child protection teams

Effective collaborative working between the different professions and agencies working to safeguard children is essential. Lack of knowledge of others' roles, perceived differences in status and expertise, and negative stereotypes are examples of why this can be difficult to achieve. A facilitated interprofessional learning (IPL) programme was implemented to assess if such an intervention could overcome some of the barriers to effective interprofessional and inter‐agency team working. Six teams based in primary and secondary care trusts took part with participants from health, education, police and social services. Quantitative and qualitative data were collected from individual participants using a pre‐validated team climate inventory and reflective statements. Findings from this study demonstrate statistically significant changes in five out of six categories in the inventory. Reflective statements suggested that overall the programme offered a positive learning experience at both an individual and team level. The importance of outside facilitation to maintain the team's momentum was acknowledged, as was the difficulty of maintaining a good level of activity once the programme had ended. Nevertheless, the IPL programme provided a timely opportunity to reflect upon the interprofessional and inter‐agency team working needed within Children's Trusts and the implications for staff involved with regard to skills development. Copyright © 2009 John Wiley & Sons, Ltd.     

The effectiveness of corporate gender equality plans in improving leave provisions for fathers in Spain

ABSTRACT

Official Spanish policy seeks greater gender equality by, among other things, encouraging men’s use of their legal rights to parental leave and requiring employers to implement equality plans. This article contains a first-ever analysis of the extent to which company equality plans are used to improve upon the legal provisions governing parental leave and whether those improvements actually encourage greater leave use by men, help to degender leave use and promote fathers’ co-responsibility for childcare. The improvements implemented by companies are analysed against a backdrop of economic crisis (2007-2016), during which public policy underwent no substantial change. An analysis of the gender equality plans in place among 107 ‘gender equality employers’ (GEEs) revealed that most included no enhancement of the existing legislation and only a few work organizations provided incentives for men to use leaves as part of their work-life balance strategies. Substantial progress in this regard can only be expected through increasing government provision of parental leave aimed at men and/or increasing government pressure on companies to encourage leave taking by men.     

Denn sie wissen was sie tun!

Information and communication technologies (IT) permeate both the business and the private world. They cause profound changes for companies in terms of structure, leadership, culture, education and the position of individuals within the context of the company. Established structures, decision making habits and methods of communication are being called into question. This means that communication is neither explicitly controllable nor in some cases even specified, but it also should not be viewed as arbitrary. Structures which are treated as contingent require meta-management, reflection and determination. Leaders are forced to act within a constellation of tensions between the reduction and the expansion of complexity as basic functions of structuring. Ideally this type of steering takes place consciously and with a view toward the future, taking into account the increasing complexity and dynamics of the environment and the corporate culture. Empirical studies of our four intervention research projects show that the situation for many companies is sobering. Companies cannot always entirely interpret the rapid development of communication technologies and the consequences it brings with it, nor can they completely make use of its potential advantages. Companies and individuals are forced to think actively within the networked economy. The demand for further education shifts between the company (expertise, employee loyalty) on the one hand and the responsibility of the individual for his or her own development on the other. Agreements are the key to bringing harmony and new solutions to the conflicts among the differing interests of individuals, subsystems and the company as a whole. Considering the complex requirements for companies and management caused by IT, this article shows that reflective observation of intervention research, guided by theory and with a focus on targeted change of management practice, is a process which provides new opportunities for action in both theory and practice. In this process, focusing (systemization) and reflection (enhancement of perspectives) are fundamental keys for dealing with complexity.     

Implementation fidelity and adolescent smoking: The X:IT study—A school randomized smoking prevention trial

BackgroundAssessing the actual implementation of multi-component interventions can provide important knowledge for future interventions. Intervention components may be implemented differently, knowledge about this can provide an understanding of which components are essential and therefore must be included. The aim of this study was to examine the implementation of one, two, or all three main intervention components at the individual level and to assess the association to current smoking among 13 year-olds in the X:IT study.MethodsData stems from a cluster-randomized controlled trial in 94 Danish elementary schools (51 intervention; 43 control schools). Implementation was measured by aspects of adherence, dose, quality of delivery, and participant responsiveness based on questionnaire data from 4161 pupils at baseline (mean-age: 12.5 years) and 3764 pupils at first follow-up eight months later. Coordinator responses from 49 intervention schools were also included. Associations between individual level implementation of the three main components and pupil smoking were examined through a 3-level logistic regression model.ResultsAlthough implementation fidelity for the three main intervention components was good, only one third (38.8%) of pupils in intervention schools were exposed to full implementation of the intervention. Among these pupils odds ratio for smoking was 0.25 (95% CI: 0.15 – 0.42).ConclusionsSchool-based programs can be very effective if carefully implemented. Future school-based smoking preventive initiatives should include multiple components, and seek to enhance implementation quality of all components.     

Using an action research approach to involving service users in the assessment of professional competence

This paper reports on a piece of action research that has involved people who use mental health services in systematically providing feedback from a user perspective on participants’ assessed work completed for one module of a masters’ training programme in mental health. In an attempt to improve professional practice and include people who were accessing mental health services in so doing, it outlines how users were trained to provide feedback and the training methods employed. The findings summarise the kind of issues users raised in their feedback to participants about the evidence professionals provided to demonstrate their learning from the training programme. A focus group interview with professionals provides a contrasting insight into the participants’ experience of having their work commented upon from a user perspective. The paper draws on the experience of a five-year external evaluation of an interdisciplinary programme in community mental health at Birmingham University in the UK which has highlighted the involvement of people who use mental health services as a particular innovation in the design, delivery and evaluation of the curriculum.     

Are the ideal worker and ideal parent norms about to change? The acceptance of part-time and parental leave at German workplaces

ABSTRACT

This study examines the extent to which the use of part-time work and parental leave is accepted at German workplaces. Is there evidence for a weakening of ideal worker and ideal parent norms? Interviews were conducted with 95 employees in different status positions in hospitals, police stations and industrial companies. The results indicate that even though ideal worker norms and ideal parent norms still prevail, especially in higher-status positions and typical male professions, they have shifted partially for some employees. Partial change can be observed for mothers in high-status positions (part-time) and for men up to mid-level positions (parental leave). There is greater acceptance of fathers’ parental leave, mainly due to the reform of the German parental leave legislation. Part-time for women in upper-level positions has become more accepted due to work-life balance policies at the company level. Norm changes, however, have stalled at the halfway mark. Fathers are still expected to prioritize their career and to schedule parental leave according to their organization’s business needs. Part-time working mothers in high-status positions are expected to deliver performance similar to that of full-time workers. Moreover, norm changes are hindered by economic constraints, mainly staff shortages.     

Multilevel community health promotion: How can we make it work?

The need for multilevel, comprehensive health promotion programmeshas become widely accepted, as has the importance of communityapproaches. However, many health promotion programmes focuson change at the individual level, no doubt partly due to thedifficulty of implementing all-inclusive health promotion. Thispaper discusses two strategies for guiding multilevel projects:multiple methods for community assessment and charting projectactivities by level of change (a possibility framework). Thesestrategies help ensure a multilevel focus and provide valuableinformation that can assist with the implementation of multilevelhealth promotion research projects in specific community contexts.Our primary purpose, therefore, is not to focus on theory orresearch findings. Rather, our goal is to make visible two strategiesthat have been helpful in one health promotion research projectin Victoria, British Columbia, Canada.